Active NPI
Kenneth G. Witt Jr., D.M.D.
- General Practice Dentistry
- Old Hickory, TN
National Provider Identifier
1700903218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS4494
- Practice address
- 14625 Lebanon Rd
Suite a
Old Hickory, TN 37138-4620 - Phone
- (615) 754-0406
- Fax
- (615) 754-0406
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS4494 | TN | Primary |
Addresses
Primary practice location
14625 Lebanon Rd
Suite a
Old Hickory, TN 37138-4620
Mailing address
115 Pennsylvania Ave
Lebanon, TN 37087-3411
Phone (615) 754-0406
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200902001204 | TN | Order and Referring Only - Dentist | 3678990827 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4494 | TN | MD | Mental Health Counselor |
| DS4494 | TN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700903218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 PENNSYLVANIA AVE",
"city": "LEBANON",
"state": "TN",
"postal_code": "370873411",
"telephone_number": "615-754-0406",
"fax_number": "615-754-0406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14625 LEBANON RD",
"address_2": "SUITE A",
"city": "OLD HICKORY",
"state": "TN",
"postal_code": "371384620",
"telephone_number": "615-754-0406",
"fax_number": "615-754-0406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITT",
"first_name": "KENNETH",
"middle_name": "G.",
"name_suffix": "Jr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "DS4494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Hickory, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.